Short- and Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Public and Private Hospital Settings: A Propensity-Matched Analysis - 03/11/21
, Shane Nanayakkara, MBBS, PhD a, c, Joshua Bowditch, MBBS a, Nay M. Htun, MBBS, PhD a, Dion Stub, MBBS, PhD a, d, Misha Dagan, MD, MMed(Epi) a, Julia Stehli, MD a, b, Ronald Dick, MBBS b, Stephen J. Duffy, MBBS, PhD a, d, Antony S. Walton, MBBS a, bAbstract |
Objectives |
To compare short- and long-term outcomes after transcatheter aortic valve implantation (TAVI) in the public and private hospital setting.
Design |
Propensity-matched, retrospective analysis of a prospective registry.
Setting and Participants |
Patients with severe aortic stenosis who underwent TAVI at a tertiary public hospital (n=507) and an experienced private hospital (n=436).
Main Outcome Measures |
The primary endpoint was all-cause mortality.
Results |
Patients that underwent TAVI in the public hospital were younger than patients in the private hospital (82±8 years vs 84±6 years, p<0.001), with lower estimated short-term mortality risk (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score >4.0%: 43% vs 56%, p<0.001). There was no difference between public and private hospitals in 30-day mortality (1.5% vs 1.2%, p=1.0), and the rate of complications was similar. Long-term survival was similar in propensity-matched public (n=344) and private (n=344) patient cohorts. The 1-year, 2-year, 5-year and 7-year survival rates were 95%, 90%, 67% and 47% in public patients, and 92%, 86%, 67% and 51% in private patients (p=0.94). In multivariable analysis, the hospital setting was not a predictor of mortality.
Conclusion |
Despite increased age and predicted mortality in private hospital patients, short- and long-term outcomes after TAVI were comparable between public and private hospital settings. This study demonstrates the feasibility of performing TAVI in a private hospital with a dedicated and experienced team and questions the current restricted access to TAVI in the private sector.
Le texte complet de cet article est disponible en PDF.Keywords : Transcatheter aortic valve replacement, Aortic stenosis, Public versus private health
Plan
Vol 30 - N° 12
P. 1910-1917 - décembre 2021 Retour au numéro
Article précédent
- Five-Year Survival of Transcatheter Aortic Valve Implantation in High-Risk Patients
- Andrew B. Haymet, Michael Seco, Christopher Brown, Cristina Cristoloveanu, Scott Murray, Jun Wu, Bruce Cartwright, Mark Adams, Michael P. Vallely, Paul G. Bannon, Michael K. Wilson, Martin K.C. Ng
- Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement for Aortic Stenosis (SAVR): A Cost-Comparison Study
- Karan K. Shah, Daniel Elder, Mai T.H. Nguyen, Lisa Turner, Mathew Doyle, Kei Woldendorp, Michael Seco, Chi Kin Law, Michael K. Wilson, Anthony Keech, Martin K. Ng, Rachael L. Morton
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